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What is Dialysis Adequacy?

On dialysis, the clearance of blood urea nitrogen (BUN) and creatinine (Cre) must meet the criteria for adequate toxin removal.

The current standard must be more than adequate dose. If the patient's dialysis dose is less than the minimal effective dose, the mortality, morbidity and average hospitalization days will increase significantly, so the clearance rate must be maintained above this level.

In comparison with the adequate dose, patients can get little additional benefit when the dialysis dose is greater than the adequate dose.

So, there should be an optimal dose, beyond which the patient gains far less than the increased expenditure. As the optimal dose is not yet established, it is currently recommended that the dose be only passively greater than the adequate dose.

Such a definition of dialysis adequacy is focused on the dialysis dose. However, a more complete definition for adequate dialysis should include dialysis mode, dialysis dose, nutrition, water and electrolyte balance, infection, anemia, and quality of life, which are best cared for, even at the level of the native kidneys.

Kidney transplantation is the only way to meet all criteria of sufficient dialysis, and hemodialysis and peritoneal dialysis are unlikely to achieve this goal. Because of short of kidney donor, kidney transplantation is only a minority for treating chronic kidney disease, and most people need dialysis treatment until they can get kidney transplantation. Therefore, for a patient with end-stage renal disease, how to achieve dialysis adequacy is a very important issue.

Dialysis inadequacy will cause the following symptoms:

• Frequent weakness and fatigue
• Dry-weight reduction
• Poor appetite
• Nausea
• Smell of urine from the mouth
• Discomfort
• Yellow skin color
• Uremic pericarditis

If you have one of the above conditions, you must need longer dialysis time or better dialysis equipment and treatment.

Doctors of the CMUH Kidney Institute will provide the most appropriate and adequate dialysis and treatment for hemodialysis patients.